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TOPLINE:

Virtual neurology care for new patients was comparable to in-person care, with similar 90-day follow-up rates, emergency department (ED) visits, and hospitalizations, a new cohort study showed. However, some outcomes differed slightly by chief neurologic complaint.

METHODOLOGY:

• A retrospective multicenter cohort study included data for more than 47,000 adults who were new patients in neurology and received virtual or in-person care between 2020 and 2021. These data were collected from the Vizient Clinical Data Base and Vizient Clinical Practice Solutions Center.
• More than 8200 virtual visits were propensity score matched with an equal number of in-person visits based on demographic and clinical characteristics, time period, and previous healthcare use. The analysis was stratified by neurologic chief complaint category and healthcare institution.
• The primary outcome was a virtual or in-person follow-up visit to the neurology clinic within 90 days of the index visit.
• Secondary outcomes included ED visits and hospitalizations for neurologic diagnoses, all-cause ED visits and hospitalizations, non-neurologic outpatient appointments, and diagnosis-specific testing — all assessed within 30 days and 90 days after the index visit.

TAKEAWAY:

• The 90-day neurology follow-up rate did not differ significantly between the virtual and in-person care groups (24.6% vs 23.7%, respectively), but the 30-day follow-up rate was slightly lower in the former group (7% vs 8%; P = .01). 6-month and 1-years visits were similar between the groups, as were rates of neurologic and all-cause ED visits and hospitalizations within 90 days.
• Participants in the virtual-care vs in-person care group were more likely to have a non-neurology clinic visit within 90 days (43% vs 41%; P < .01).
• The 90-day follow-up rates were higher after in-person visits for dementia and after virtual visits for headache, and 30- and 90-day follow-up rates were higher after virtual visits for Parkinson’s disease and multiple sclerosis (P < .01 for all).
• Completion of any epilepsy-related test among patients with epilepsy and a polysomnogram among those with sleep disorders was more likely after in-person visits at 30 and 90 days (P < .01 for both). At 90 days, a brain MRI for headache was more common after in-person visits and hospitalization for stroke was more common after a virtual visit (P = .02 for both).

IN PRACTICE:

“Our results suggest that virtual visits are appropriate for an initial neurologic evaluation across a range of conditions,” the lead investigator said in a press release.

“Future research should investigate more fully if people with different conditions may benefit more from one particular type of visit,” she added.

SOURCE:

The study, led by Chloé E. Hill, MD, University of Michigan, Ann Arbor, Michigan, was published online on April 22 in Neurology.

LIMITATIONS:

Researchers could not determine why patients were triaged to one care modality over another, introducing potential selection bias. The study occurred in the prevaccine phase of the COVID pandemic, when care‑seeking behavior may have been altered; therefore, generalizability of the observed behavior to later years was limited. Unmeasured differences between cohorts remained, and variables such as clinician subspecialty were incompletely reported. Additionally, the analysis did not consider cost differences and the time spent by clinicians.

DISCLOSURES:

The study was funded by the American Academy of Neurology Health Services Research Subcommittee. Disclosure information for the study investigators is available in the original study publication.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.